Why the acting Surgeon General thinks skin cancer is a ‘major public health problem’


Rear Admiral and Acting U.S. Surgeon General Boris D. Lushniak discusses health topics during the Washington Post forum: Health Beyond Health Care in Washington, DC, June 18, 2014 (Evelyn Hockstein for The Washington Post).

Acting U.S. Surgeon General Boris D. Lushniak wants to shine a spotlight on the nation's ever-growing number of skin cancer cases, calling it a "major public health problem that requires immediate action."

In a report set for release Tuesday, Lushniak highlights some disquieting facts about the disease and its most deadly form, melanoma. There are 63,000 new cases of melanoma diagnosed each year, and an estimated 9,000 annual deaths from the disease, many of them involving teens and young adults.

The report, the first time the surgeon general has publicly focused on skin cancer, urges ordinary Americans to take long-recommended preventive steps such as wearing sunscreen and seeking shade when outdoors. But it also calls on other sectors of society, from researchers to policymakers, to play a role in turning back the tide of the disease.

Lushniak spoke to The Washington Post ahead of Tuesday's report. The following transcript has been edited for length and clarity:

WP: Can you explain the urgency around this issue?

Lushniak: Right now we're seeing kind of a bad trend developing when it comes to skin cancers. Skin cancers - melanoma and non-melanoma skin cancer - are increasing. It got to the point for us, right now, to be able to say, "We need to have this call to action."

Certainly, this time of year, we're in the midst of this vacation season. Knowing that as August comes around, it's the last big spurt of people heading to the beach, people spending time having that potential exposure to ultraviolet radiation. We thought now was a really good time to get the message out.

WP: As you noted, melanoma diagnoses seem to be increasing as other forms of cancer are decreasing. Can you explain a little bit about why that is happening?

Lushniak: It's difficult to say. We've seen increases [in melanoma cases] - almost a tripling over the last 30 years. And of course, the question is, is it based upon ultraviolet exposure? Increased outdoor activities? The indoor tanning industry and artificial sources of ultraviolet radiation? From our perspective, the real concern is that this is an increase, and we need to do something about it.

WP: But we don't know for sure what's causing the increase?

Lushniak: In essence, we really don't. From the epidemiological surveillance perspective, we see the numbers increasing. But in terms of looking at specific [causes] of that, it's still difficult to determine.

WP: Your report mentions indoor tanning. What role do we believe indoor tanning plays in melanoma? And what more can be done about that? There are state regulations. The FDA has proposed some tighter regulation on tanning beds.

Lushniak: I've got to, as acting surgeon general, call out the facts. And the facts are that indoor tanning is a source of ultraviolet radiation, period. Ultraviolet radiation is a known carcinogen, period. This is a needless exposure to ultraviolet radiation. According to research...we're looking at about 400,000 cases of skin cancer, about 6,000 of them melanomas, that are estimated to be related to indoor tanning in the United States each year. So I have to look at this as being a major problem. We certainly know it's something that's become popular amongst youth. And much like the surgeon general comes out very vehemently against youth smoking, I am coming out quite vehemently against youth exposing their skin to ultraviolet radiation in tanning booths.

We still have an issue with the concept of social norms. Is tan a good thing or a bad thing? A lot of times we compliment people, "Oh, you look so tan. You're so relaxed. You must have been on vacation." Part of the thing we really want to emphasize in this call to action is that tanned skin is damaged skin.

WP: Speaking of a call to action, this report asks a variety of people and businesses and health-care providers to do more. What do you want different sectors to do?

Lushniak: One of our goals in this whole report is to provide individuals with the information they need to make informed, healthy decisions about UV exposure. We're encouraging people to enjoy the outdoors. But as you're out there exercising, doing all those nice outdoor activities, protect yourselves. It's the concept of the floppy hat, the sunglasses, the sunscreen, protective clothing and seeking shade when possible.

When we talk about the other sectors, we tap into society in general. We do have the ability to put up shady areas. We have the ability to have canopies out there so people can enjoy the outdoors and at the same time be protected. We also [should be] promoting policies that advance the national goal of preventing skin cancer. Certainly, at the state level, there have been some regulatory approaches taken regarding use of tanning beds in minors. We're certainly supportive of that.

In the bigger picture, it's really going to the research community, the scientific community [as well]. We're really calling everybody to task [in hopes of] strengthening the research in this area, the surveillance of these diseases, the monitoring and evaluation related to skin cancer prevention.

WP: How do you look at melanoma in comparison to other cancers? There are cancers that more people die from than this.

Lushniak: I am a dermatologist, so this is an area I've been passionate about. I've trained in skin diseases. I've seen patients with a variety of skin cancers, including people who have died from skin cancer. And it brings to the forefront the facts about melanoma - it's the deadliest form of skin cancer. Each year we have 63,000-plus cases diagnosed, nearly 9,000 people die. That's one person every single hour that's dying from melanoma. I mentioned the increase over the past 30 years. But also, it's one of the most common types of cancer amongst U.S. teens and young adults. So when we're looking at impact, the term in epidemiology that we use is "years of potential life lost." We're really talking about a tragic disease here, something that really affects the young. That's something, from a public health perspective, we have to do something about.

Brady Dennis is a national reporter for The Washington Post, focusing on food and drug issues.
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